Executive summary
The Australian Prime Minister Julia Gillard urged liberal premiers not to politicize the implementation of the National Disability Insurance Scheme (NDIS). The proposal to have a national insurance scheme that provides financial support to disabled Australians is not only timely but also beneficial. However, it could be derailed due to political influence and lack of financial support. The implementation of the policy is expected to reduce the economic uncertainties people with disabilities are facing. The major beneficiaries of the NDIS include people with disabilities, their families, and caregivers. Some of the major benefits of the NDIS include financial support for prosthetics, therapies, accommodation support, vehicle modification, and respite care, among others. Economic factors affect the efficient delivery of health care services. From a social perspective, all persons with a disability will improve their health and benefit from modern healthcare services and facilities. Regarding political influence, some of the politicians have shown reluctance with supporting the scheme.
Introduction
Prime Minister (PM) Julia Gillard has advised Liberal premiers to support the National Disability Insurance Scheme (NDIS) and keep matters of health away from politics. In addition, “the PM has urged fellow premiers to ‘do the right thing’ and find extra money for an NDIS” (Hudson and AAP, 2012). According to the premier, issues of incorporating a national insurance policy that caters to people with disabilities should not be politicized. The disability reform is expected to have a significant impact on the lives of Australians by ensuring that disabled people have access to health insurance coverage. However, various factors ranging from economic, social, political, to health perspectives (Hudson and AAP, 2012) influence the issue. This paper explores the economic, political, sociological, epidemiological public health factors affecting the implementation of the NDIS, and their effect on the health policy in response to the growing needs of the community.
National Disability Insurance Scheme (NDIS) The NDIS scheme is fully funded by the Australian government and is expected to overhaul disability funding in the country. The first phase of the scheme is expected to cater to over 200, 0000 Australians who live with a disability. Some of the services offered under the NDIS include financial support for prosthetics, therapies, accommodation support, vehicle modification, and respite care (Jamieson, 2011; Council of the Australian Governments, 2012). Provision of these services under the scheme is anticipated to cost the Australian government approximately $ 6.5 billion annually (Jamieson, 2011). Most of the states in Australia are in support of the scheme although some are yet to show their financial support. Beneficiaries of the scheme include people living with disabilities, caregivers, and their families (Commonwealth of Australia, 2012). Previously, existing health policies failed to take into account the needs of disabled people. As a result, the marginalization of disabled persons prevented them from accessing modern health care services, care, as well as facilities.
Economic Perspective
According to Palmer and Short (2010), the economic perspective examines the determinants of health care utilization and expenditure to ensure optimum efficiency that is measured in terms of demand and supply. Proper health care depends on the individual’s ability to afford the service as well as the capacity of hospitals to provide the necessary medical care (Mulgan, 2008). The idea to provide healthcare insurance to the disabled population in Australia through NDIS is timely since the scheme will provide financial cover at the national level in addition to meeting the demand for healthcare services (Palmer and Short, 2010). The implementation of NDIS will benefit over 20,000 people with disabilities who cannot afford healthcare services and facilities (Jamieson, 2011).
Given that the risks associated with financial outlays are unevenly distributed across the community (Palmer and Short, 2010), the use of health insurance schemes such as NDIS can spread out financially unequal risks across the affected population (Manne, 2011; Salusinszky, 2012). However, health care policies cannot be implemented without the appropriate financial backing (Aulich and Evans, 2010). Owing to the complexity of the Australian healthcare system, the level of health insurance coverage will be influenced. Consequently, the private sector has benefited because of a monopoly in the health care system (Moorin and Holman, 2005; Pezzulo, 2011).
Political Perspective
The political influence on health policy depends on socioeconomic status and geographic location. This, in turn, affects the distribution of resources between different health services, such as preventive, curative, and institutional. According to Palmer and Short (2010), the government has a political role to play in ensuring that health policies are implemented.
Over the past few years, there has been inadequate political support to champion the welfare of disabled persons. This is an indication of the extent to which political interference can affect the development of effective health policies when it comes to financing. The proposal to have a national health care insurance coverage in Australia that caters to disabled people is crucial to the country’s health care. Champions of the scheme, such as Julia Gillard, are a reflection of the extent to which political processes are willing to go to transform the Australian health care system (ABC, 2012). However, other leaders and the leading states have demonstrated a lack of political will to support the scheme (Hudson and AAP, 2012). For example, Premier Colin Barnett has publicly expressed his doubts over the scheme, especially the federal plan that requires all states to dismantle the already existing disability plans and endorse a nationwide plan (Jamieson, 2011; Farr, 2011).
Social Perspective
The consideration of sociological arguments in the study of health policy in Australia provides an insight into the societal and cultural correlations between health care systems and the communities. The social perspective in healthcare is concerned with fairness and equity in the provision of health care services (Palmer and Short, 2010). By implementing NDIS, the main beneficiaries shall be persons will disabilities, caregivers, and families of disabled people (Commonwealth of Australia, 2012).
According to Palmer and Short (2010), ethical considerations play a key role in the formulation of health policies, health care decision making, and medical research due to concerns involving subjects, such as cloning, abortion, and surrogacy, among others. Ethical considerations in medicine can be categorized into micro-level ethics, which are applied in clinical decision-making, and macro-level ethics that monitor the privileges of states and communities (Hacker & O’Leary, 2012). Puska & Ståhl (2010) state that power relations between doctors and patients occur when the doctors assume the best care for their patients without considering the opinions of the latter. Consequently, sociological and political elements are necessary for comparing the ethical decisions of patients and nurses to those of doctors in medical practice.
Health sociologists argue that professional dominance shapes the health care systems due to their autonomy (Palmer & Short, 2010). The freedom of the medical profession from outside scrutiny from authorities frees it from the shortcomings in the health policy. In addition to self-authority, the medical profession also models the beliefs of society about the management of health problems. Evaluations in the medical profession are conducted by peers within the profession, which allows them to make clinical and technical decisions without being accountable to external bodies.
The autonomy of the medical profession gives it a competitive advantage over other practitioners since they have the mandate to hospitalize patients, prescribe drugs, and order laboratory tests. In addition to this, the federal government caters for the bills of patients under the Medicare Scheme, who seek treatment from registered medical practitioners (Palmer and Short, 2010). Autonomy, in turn, gives rise to power relations between doctors and patients. They occur when the doctors assume the best care for their patients without considering the opinions of the latter.
Palmer and Short (2010) suggest that the rationality behind interests forms the basis of other perspectives involved in the evaluation of health policies. The notion of interest looks at the needs of individuals or organizations in the delivery of medical care and the role of political demands on the system. Hacker and O’Leary (2012) suggest that the interests of individuals and groups are best revealed through the media. This way their grievances and suggestions can be considered in the policy agenda within a democratic political system.
Political influence has hindered the development in the healthcare sector (Dwyer and Eadger, 2008). The fragmentation may be as a result of excluding medical professionals, who have greater beliefs and values related to healthcare and healthcare provision in policy implementation (Palmer and Short, 2010; Manne, 2011). In addition, bureaucracy and different opinions have been a significant setback for the Productivity Commission while developing and communicating this policy (Hacker and O’Leary, 2012).
Epidemiological perspective
This perspective examines the determinants of the incidence and prevalence of the disease. According to Palmer and Short (2010), members of the public, clinicians, and politicians have a role to play in ensuring that people with disabilities get appropriate health care services without unnecessary delay. From a health care perspective, the government and society play a vital role in restoring community health. Through the implementation of relevant schemes and programs, the welfare of the whole population is covered (Manne, 2011). Increased effectiveness in the healthcare sector is the driving force of NDIS.
The implementation of NDIS has potential benefits such as improved health care for disabled persons (Healy, 2011). However, these benefits will not be achieved if not all states commit themselves financially. The policy has been termed a ‘cruel lottery’ (Forrester and Griffiths, 2010), with negative outcomes, such as dismantling of existing programs (Farr, 2011) being a drawback in designing health insurance policies that deals with disabled Australians, who can hardly afford modern healthcare services and facilities.
Conclusion
The assessment of the health care system in Australia requires one to be aware of the various perspectives involved in policymaking and policy implementation. Several factors are drawn from economic, political, sociological, epidemiological, and public health perspectives influence policy implementation and planning. Health care policies at the national level are required to ensure fairness and equity in the provision of health services (Puska and Ståhl, 2010). The financial disparity across Australia calls for the need to have an NDIS, which covers all individuals. Despite the setbacks in its implementation, there is no doubt that people with disabilities stand to benefit immensely from the NDIS. In addition, the health of persons with disabilities will be improved, and effectiveness in the healthcare sector increased. People with disabilities, caregivers, and their families will also benefit from the scheme. Benefits of the NDIS include financial support for prosthetics, therapies, accommodation support, vehicle modification, and respite care.
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